Salvage Resection for Local Failure after Stereotactic Ablative Radiotherapy for Pulmonary Malignancies: A Retrospective, Single-Center Study.

Abstract

Background: Salvage resection after radiotherapy is technically challenging, and patients are vulnerable to postoperative complications. Outcomes of salvage lung resection after stereotactic ablative radiotherapy (SABR) are not well established. We aimed to assess the feasibility and safety of salvage resection for local failure after SABR.

Methods: We identified patients treated with SABR for primary or secondary lung malignancies from 2012 to 2018 who subsequently underwent salvage resection for local recurrence at the SABR-treated site. Detailed patient data were retrospectively collected. Short-term postoperative outcomes and mid-term recurrence rates were evaluated.

Results: Of 741 patients who received SABR, 16 underwent 17 salvage procedures for local failure. Pulmonary metastasis from colorectal cancer (n=12; 71%) was the most common pathology. The median time from SABR to local recurrence was 15.9 months (interquartile range [IQR], 8.6-21.5 months). Video-assisted thoracoscopic surgery was performed in 13 of 17 operations, and R0 resection was achieved in all cases. Eight lesions required anatomic resection to achieve complete removal. Postoperative bleeding requiring surgical intervention occurred in 1 patient (6%) and was unrelated to prior radiation. No 30- or 90-day mortality was recorded. The median hospital stay was 4 days (IQR, 4-6 days), and the median follow-up duration was 58.1 months (IQR, 31.5-72.1 months). Although 4 patients developed distant metastases after salvage resection, none experienced local failure.

Conclusion: Salvage resection can be a safe and effective treatment for local failure after SABR. Careful selection of eligible patients is essential.